| NPI | 1093087579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS19751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 075156) |
| 207R00000X Internal Medicine (Licence: FL OS19751) | |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2025-12-02 |